| NPI | 1831684414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0010517) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03337353) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-11-07 |